MEDICARE: LYNDA R. COLAIZZI, DMD, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN11046	FL

General Provider Information

NPI Number	:	1255574893
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LYNDA R. COLAIZZI, DMD, PA

Provider Business Mailing Address
First Line	:	1445 ALEGRIANO AVE
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33146-1601
Country	:	US
Telephone Number	:	305-790-3361
Fax Number	:

Provider Business Practice Location Address
First Line	:	1445 ALEGRIANO AVE
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33146-1601
Country	:	US
Telephone Number	:	305-790-3361
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LYNDA R. COLAIZZI
Credential	:	DMD, PA
Telephone Number	:	305-790-3361

Provider Enumeration Date	:	04/13/2009
Last Update Date	:	08/27/2013

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